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The Utility of Diagnostic Laparoscopy in Post-Bariatric Surgery Patients with Chronic Abdominal Pain of Unknown Etiology

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Abstract

Purpose

Chronic abdominal pain after bariatric surgery is associated with diagnostic and therapeutic challenges. The aim of this study was to evaluate the yield of laparoscopy as a diagnostic and therapeutic tool in post-bariatric surgery patients with chronic abdominal pain who had negative imaging and endoscopic studies.

Methods

A retrospective analysis was performed on post-bariatric surgery patients who underwent laparoscopy for diagnosis and treatment of chronic abdominal pain at a single academic center. Only patients with both negative preoperative CT scan and upper endoscopy were included.

Results

Total of 35 post-bariatric surgery patients met the inclusion criteria, and all had history of Roux-en-Y gastric bypass. Twenty out of 35 patients (57%) had positive findings on diagnostic laparoscopy including presence of adhesions (n = 12), chronic cholecystitis (n = 4), mesenteric defect (n = 2), internal hernia (n = 1), and necrotic omentum (n = 1). Two patients developed post-operative complications including a pelvic abscess and an abdominal wall abscess. Overall, 15 patients (43%) had symptomatic improvement after laparoscopy; 14 of these patients had positive laparoscopic findings requiring intervention (70% of the patients with positive laparoscopy). Conversely, 20 (57%) patients required long-term medical treatment for management of chronic abdominal pain.

Conclusion

Diagnostic laparoscopy, which is a safe procedure, can detect pathological findings in more than half of post-bariatric surgery patients with chronic abdominal pain of unknown etiology. About 40% of patients who undergo diagnostic laparoscopy and 70% of patients with positive findings on laparoscopy experience significant symptom improvement. Patients should be informed that diagnostic laparoscopy is associated with no symptom improvement in about half of cases.

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Authors and Affiliations

  1. Bariatric and Metabolic Institute, Department of General Surgery, Cleveland Clinic, 9500 Euclid Avenue, Desk M61, Cleveland, OH, 44195, USA

    Mohammad Alsulaimy, Suriya Punchai, Matthew Kroh, Philip R. Schauer, Stacy A. Brethauer & Ali Aminian

  2. Department of Surgery & Urology, Al-Sabah Hospital, Ministry of Health, Kuwait, Kuwait

    Mohammad Alsulaimy

  3. Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

    Suriya Punchai

  4. Imaging Institute, Cleveland Clinic, Cleveland, OH, USA

    Fouzeyah A. Ali

Authors
  1. Mohammad Alsulaimy
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  2. Suriya Punchai
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  3. Fouzeyah A. Ali
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  4. Matthew Kroh
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  5. Philip R. Schauer
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  6. Stacy A. Brethauer
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  7. Ali Aminian
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Correspondence to Ali Aminian.

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The authors declare that they have no conflict of interest.

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Alsulaimy, M., Punchai, S., Ali, F.A. et al. The Utility of Diagnostic Laparoscopy in Post-Bariatric Surgery Patients with Chronic Abdominal Pain of Unknown Etiology. OBES SURG 27, 1924–1928 (2017). https://doi.org/10.1007/s11695-017-2590-0

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  • DOI: https://doi.org/10.1007/s11695-017-2590-0

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